tbuckley/cabot-search huggingface dataset:
Abstract 9610: Endothelial Function and Coronary Arterial Imaging in Youth-Onset Type 2 Diabetes: Evidence for Early Vascular Aging Compared to Age-Matched Peers
Authors: Khaled Abd-Elmoniem, Alfredo Villalobos-Perez, Jehad Edwan, Jatin Matta, Katrina Dietsche, Sydney Dixon, Jenna Feeley, Michael Stagliano, Lilian Mabundo, Ahmed M Gharib, Stephanie T Chung
Journal: Circulation (2022)

Introduction: Youth-onset type 2 diabetes (Y-T2D) may be associated with accelerated vascular aging, but the tempo and mechanisms are unknown. Non-invasive cardiac MRI coupled with ex-vivo experiments to assess endothelial function are ideal for assessing risk in young adults. Plasma exosomes are pro-inflammatory extra-cellular vesicles that may modulate endothelial dysfunction. Methods: We hypothesized that Y-T2D would have endothelial dysfunction compared to healthy age-matched peers measured by right coronary wall thickness (CWT) and coronary and brachial artery dilation during isometric handgrip exercise using a 3.0 Tesla cardiac MRI. In a subset of 4 Y-T2D, we isolated, characterized, and incubated plasma-derived exosomes in human coronary artery epithelial cells (HCAECs) compared to control cells. Results: Y-T2D (n=14, 40% female, age 19.4±1.3y, BMI 38±9kg/m 2 , mean±SD) compared to peers (n=16, 40% female, age 22.9±2.6 y, BMI 23±3 kg/m 2 ) had higher HbA1c (6.5 ± 1.2 vs 5.0 ± 0.5%), C-reactive protein (6.5±8.3 vs. 3.1±2.0 mg/L), systolic blood pressure (130±14 vs. 114±11 mmHg, all P &lt;0.05) but similar LDL-cholesterol and triglycerides. Y-T2D had greater CWT (1.34±0.13 vs. 1.22±0.13 mm, P =0.02) and impaired arterial dilation (Figure 1A). HCAECs incubated with Y-T2D exosomes induced phenotypic changes of endothelial dysfunction: reduced expression of phosphorylated endothelial nitric oxide synthase (peNOS), increased expression of endothelial membrane ICAM-1 and phosphorylation of pERK(1/2) (Figure 1B). Conclusion: Accelerated vascular aging in Y-T2D was associated with paradoxical exercise-induced coronary artery vasoconstriction and peripheral endothelial dysfunction despite young age and the absence of traditional risk factors such as severe hyperglycemia, frank hypertension, or dyslipidemia. Plasma exosomes should be explored in the pathogenesis of endothelial dysfunction and early vascular aging in Y-T2D.
Abstract 281: External Validation Of The Tips65 Score For Predicting Good Neurological Outcome In Out-of-hospital Cardiac Arrest Patients Treated With Extracorporeal Cardiopulmonary Resuscitation
Authors: Yuto Makino, Yohei Okada, NORIHIRO NISHIOKA, Takeyuki Kiguchi, Tetsuhisa Kitamura, Taku Iwami
Journal: Circulation (2022)

Introduction: Estimating prognosis after out-of-hospital cardiac arrest (OHCA) at early timing during resuscitation efforts is important to select appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR). The TiPS65 scoring system is a prediction model that can be used for predicting favorable neurological outcome of adult OHCA patients treated with ECPR using the following four variables: time from call to hospital arrival, initial cardiac rhythm on hospital arrival, initial pH value, and age. However, it is not yet externally validated. We aimed to perform the external validation of the TiPS65 score. Methods: This prognostic study used data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a nationwide, multicenter, prospectively registered database including 83 emergency departments in Japan from January 2018 to December 2019. All adult OHCA patients with shockable rhythm who were treated with ECPR were included. The primary outcome was 30-day survival with favorable neurological outcome defined as Cerebral Performance Category 1 or 2. The predicted probability of outcomes in this cohort was calculated according to the formula developed in the original study. The discrimination and calibration performances were investigated with c-statistic and calibration plots, respectively. Results: A total of 590 patients (men: 517 [81.6%], median age [interquartile range]: 60 [50-69] years) were included, and favorable neurological outcome were reported in 64 (10.8%). The c-statistic of the prediction model was 0.752 (95% CI: 0.694-0.81). The mean predicted probabilities were 1.6% (range: 1.6%-1.6%), 4.5% (3.1%-5.9%), 12% (10.1%-13.9%), 26.2% (22.7%-29.7%), and 48.8% (48.8%-48.8%) for a TiPS65 score of 0, 1, 2, 3, and 4, respectively. These scores were generally well-calibrated to the observed outcomes. Conclusions: In our external validation study of the TiPS65 score for OHCA patients treated with ECPR, the score showed good discrimination and calibration performances. This score would be helpful in the decision-making process for patient selection for ECPR after OHCA.
Abstract 260: The Relation of Country-of-Birth With Willingness to Respond to Out-of-Hospital Cardiac Arrest in Multiethnic Communities of New South Wales (NSW), Australia
Authors: Sonali Munot, Julie Redfern, Janet Bray, Blake Angell, Adrian Bauman, Andrew Coggins, Alan Robert Denniss, Cate Ferry, Garry Jennings, Pramesh Kovoor, Saurabh Kumar, Kevin Lai, Sarah Khanlari, Simone Marschner, Paul Middleton, Michael Nelson, Ian Oppermann, Christopher Semsarian, Lee Taylor, Matthew Vukasovic, Matthew Vukasovic, Sandra Ware, Clara K Chow
Journal: Circulation (2022)

Introduction: Bystander response including cardiopulmonary resuscitation (CPR) is critical to survival in out-of-hospital cardiac arrest (OHCA). Poorer outcomes have been reported in some immigrant communities but there has been less research about bystander response in these communities. Over a third of New South Wales (NSW) residents were born outside Australia. Hypothesis: Country of birth may explain variation in willingness to respond to OHCA. Methods: A survey was conducted between May 2021-May 2022. It employed multiple recruitment approaches including reaching out to 72 organisations and targeting multi-ethnic community organisations, advertising via social media, and leveraging local networks. Data were collected on demographic variables, CPR training, and attitudes towards responding to OHCA. Results: Of the 1267 respondents (average age 49.6 years, 52% female), 60% were born outside Australia; of which 44% (n=332) were from South Asia, 33% (n=246) from East Asia and the remaining 23% from a mix of other regions including north-west Europe, north Africa-middle east. Most immigrant respondents (73%) had lived in Australia for over ten years. Higher rates of previous CPR training were reported in Australian-born participants compared with South Asian-born and East Asian-born (76%, 35%, 47% respectively p&lt;0.001) with current training rates i.e. in last 12 months (16%, 6%, 12% respectively, p=0.003). Higher rates of willingness to perform CPR on someone they did not know, was reported in Australian-born participants compared to South Asian-born and East Asian-born (74%, 63%, 56% respectively, p=&lt;0.001. After adjusting for age, gender, education, employment status, self-reported general health, and previous CPR training, the odds of reporting willingness to perform CPR was OR:0.73 (95% CI: 0.51-1.04) among respondents born in South Asia and OR:0.58 (95% CI 0.41-0.83) among those from East Asian countries compared with Australian-born. Conclusions: Improving access to training and addressing barriers to response in multi-ethnic communities may improve willingness and consequently response to OHCA.
Abstract 9543: Cilostazol Improves Symptom Scores and Lowers NT-proBNP in HFpEF Preliminary Results From the CLIP-HFpEF N-of-1 Study
Authors: Norman N Aiad, Tamas Alexy, Michael J Zhang, Prabhjot S Nijjar, Thanat Chaikijurajai, Cindy M Martin, Markus Meyer
Journal: Circulation (2022)

Introduction: Although heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly common, targeted HFpEF therapies remain limited. Current evidence-based treatment options are modestly effective and provide limited symptom relief. Hypothesis: Cilostazol, a generic and oral phosphodiesterase type 3 (PDE-3) inhibitor, rapidly improves HF symptoms and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in HFpEF patients with an ejection fraction of 50% or higher. Methods: A prospective, double-blind, n-of-1 study with three crossovers with unblinding at the 1-month endpoint was designed. Stable outpatients with HFpEF received either placebo twice daily or Cilostazol 100mg twice daily for one week followed by three weekly crossovers. HF symptoms were assessed each week using the Kansas City Heart Failure Questionnaire (KCCQ-12) and NT-proBNP levels were measured at the end of weeks one and four. Results: Preliminary data from the initial 11 participants are presented (six men and five women, mean age 67±13 years). The mean KCCQ-12 score was eight points higher with Cilostazol than placebo (47±12 vs. 39±12; p&lt;0.05) (Figure 1A). Median NT-proBNP levels were lowered by 22% with Cilostazol compared to placebo (412 [293-1066] pg/dL vs. 659 [323-897] pg/dL; p&lt;0.05) (Figure 1B). Conclusions: In this preliminary analysis of CLIP-HFpEF, treatment with Cilostazol led to a rapid alleviation of HF symptoms and a decline in NT-proBNP levels when compared to placebo. The results of CLIP-HFpEF suggest a marked benefit of Cilostazol in HFpEF patients. Further studies are needed to elucidate the mechanism and long-term clinical benefits of Cilostazol in patients with HFpEF.
Abstract 9624: Major Adverse Cardiac Events of PCSK9 Modulation by Monoclonal Antibodies vs Small Interfering Ribonucleic Acid Inhibitors. A Meta-Analysis of 92,775 Patients
Authors: Jesus Diaz Acevedo, Mariana Soto, Carlos Penaherrera, Adela Castro, Andres F Buitrago, Viviana Navas, Jesus Pino
Journal: Circulation (2022)

Introduction: Incliciran, a small interfering ribonucleic acid (siRNA), is the new modulator of the proprotein convertase subtilisin kexin 9 (PCSK9) that has proven safe and effective in reducing LDL-C and ASCVD. However, it is unclear if incliciran is superior to the already established PCSK9 monoclonal antibodies (mAb) in reducing major adverse cardiac events (MACE). Methods: We performed a meta-analysis of randomized controlled trials of patients with high cardiovascular risk who underwent PCSK9 inhibition by either mAb or siRNA. The primary outcome was the reduction of MACE. Results: Thirty RCTs with a total of 92,775 patients were included. For patients with a high cardiovascular risk profile, the modulation of PCSK9 by mAb decreases the risk of MACE (HR 0.84, 95% CI 0.8 - 0.89, p&lt;0.0001) compared with statins and/or ezetimibe. Similar effects occurred when siRNA (HR 0.78, 95% CI 0.63 - 0.97, p=0.024) was compared to statins alone. The impact on MACE was no different between mAb and siRNA modulation of PCSK9 (p=0.49) (figure 1). When PCSK9 inhibitors were compared to statins monotherapy, only evolocumab and incliciran were statistically significant in reducing MACE (p&lt;0.0001 and p=0.024, respectively). An additional analysis of all studies, including those with statins plus ezetimibe, showed that all therapies except bococicimab (p=0.309) reduced MACE (figure 2). Conclusions: This study suggests that PCSK9 inhibition by siRNA is as effective as mAb PCSK9 for reducing MACE in patients with a high cardiovascular risk profile, with the convenience of being administered twice a year.
Abstract 9812: Abracadabra Alakazam: Sudden Invasion of the Pericardium by <i>Haemophilus Influenzae</i>
Authors: Evan Harmon, Alan Kiang, Patrick H Collier, Christine L Jellis, Venu Menon
Journal: Circulation (2022)

A 25 year old man presented with three days of cough, shortness of breath, and pleuritic chest pain. Initial vital signs in the ED were normal, and exam demonstrated tonsillar erythema without exudate. Labs revealed a leukocytosis of 18.9k/μL, D-dimer of 690 ng/mL, C-reactive protein of 5.7 mg/dL, and lactate elevated to 2.9 mmol/L. High-sensitivity troponin, NT-proBNP, and SARS-CoV-2 RT-PCR were all negative. Presenting electrocardiogram demonstrated PR elevation in aVR with diffuse ST-segment elevation in the inferior and anterolateral leads. Point-of-care echocardiogram demonstrated normal biventricular function without pericardial effusion. CTPA was negative for pulmonary embolism, and he was observed for presumed acute viral pericarditis. Fourteen-hours later, he became febrile to 38.3°C, tachycardic to 133 bpm, and hypotensive to 97/65 mmHg with diffuse abdominal pain. Repeat lactate was 9.0 mmol/L. This prompted an emergent CT scan which now showed a new large pericardial effusion and bilateral pleural effusions ( Panel A ). Repeat echocardiogram confirmed a large circumferential pericardial effusion with early signs of tamponade including right atrial inversion in late diastole ( Panel B ). Emergent pericardiocentesis yielded 560 mL of brown, purulent fluid ( Panel C ) with immediate improvement in hemodynamics. Bacterial gram stain and culture grew Haemophilus influenzae ( Panel D ). Immunodeficiency screening was negative. Transient severe biventricular systolic dysfunction was noted, consistent with sepsis-induced cardiomyopathy. He completed a targeted antibiotic course with partial recovery of his ejection fraction by discharge. Purulent pericarditis is rare in developed countries, and invasive H. influenzae in a young, immunocompetent adult is particularly unusual. This case illustrates the importance of early diagnosis and management of purulent pericarditis given its potential for rapid progression and high mortality.
Abstract 9365: Clinical Profiles and One-Year Outcome in Middle Eastern Patients With Atrial Fibrillation and Diabetes Mellitus: The Jordan Atrial Fibrillation Study
Authors: Basil Abdin, Ayman J Hammoudeh, Nasr Alrabadi, Mohammad Krishan, Lubna Haikal, Noor Badaineh, Yazan Ghanameh, Imad Alhaddad
Journal: Circulation (2022)

Introduction: Comorbid diabetes mellitus (DM) is highly prevalent and increases the risk of stroke and cardiovascular death in patients with atrial fibrillation (AF). The data on the impact of DM on Middle Eastern patients with AF including clinical features, use of oral anticoagulant agents (OACs) and the one-year outcome is scarce and not well studied. Purpose: To study the clinical characteristics, therapeutic strategies and one-year complications in AF patients with DM compared to non-diabetic AF patients. Methods: The Jordan AF Study enrolled consecutive patients with AF in 28 hospitals and cardiology clinics in Jordan from May 2019 through December 2020. Patients were followed up for one year. We compared the clinical features, use of pharmaceutical agents, and outcome in patients with DM compared to those with no DM. Results: Of the 2020 AF patients enrolled, 881(43.6%) had DM. Patients with DM were older than those with no DM (mean age +/- SD: 70.3 +/- 9.5 years vs. 66.0 +/- 14.8 years, p&lt;0.001), more likely to be women, and had a significantly higher prevalence of hypertension, heart failure, and chronic kidney disease. Mean CHA2DS2-VASc and HAS-BLED scores were higher in DM patients than in those with no DM (4.5 +/- 1.5 vs. 2.7 +/- 1.7, p&lt;0.001) and (1.9 +/- 1.1 vs. 1.4 +/- 1.0, p&lt;0.001), respectively. Also, DM patients in comparison to those with no DM had a high-risk CHA2DS2-VASc score (of 2 points or more in men and 3 or more in women) (90.9% vs. 69.0%, p&lt;0.001). OACs were prescribed equally in both groups (89.1% vs 89.5%, P=0.88). At one year, DM group compared to no DM had significantly higher rates of all-cause death (17.5% vs. 8.4%, p&lt;0.001), cardiac death (9.5% vs. 5.1%, p=0.003), major bleeding events (3.8% vs. 1.7%, p=0.007), and higher incidence of stroke/systemic embolism (4.3% vs. 2.8%, p=0.10), but similar incidence of intracranial bleeding (0.6% vs. 0.5%, p=0.98). Multiple logistic regression analysis showed that DM was associated with a higher incidence of all-cause death (odds ratio 1.5, 95% confidence interval 1.1-2.1, p=0.01). Conclusions: In this contemporary study of Middle Eastern patients with AF, a coexisting DM was associated with a worse clinical profile, risk scores, and one-year outcome. Both groups had equally high utilization of OACs.
Abstract 9748: Association of Home-Based Cardiac Rehabilitation With Hospitalization Among a Diverse Cohort of Women With Cardiovascular Disease: A Propensity Score-Matched Study
Authors: Michael Najem, Mark Duggan, Rebecca Gambatese, Chileshe Price
Journal: Circulation (2022)

Prior studies have demonstrated that home-based cardiac rehabilitation (HBCR) has similar outcomes compared to center-based cardiac rehabilitation (CBCR), however these studies have enrolled few women. The purpose of this study was to compare 12-month hospitalization rates among women who participated in HBCR and CBCR within an integrated health system in Southern California. Using a retrospective cohort design, we evaluated women referred to HBCR and CBCR in Kaiser Permanente Southern California from April 1, 2018, to April 30, 2019. HBCR involved home-based exercise for 8 weeks complemented by a smartwatch exercise monitor and telephone support. CBCR involved center-based exercise sessions three times per week for a total of 36 sessions. Attendance of ≥1 session defined participation. After propensity score matching for age, race, Charlson score, referral reason, BMI, smoking history, atrial fibrillation, hypertension, prior MI, prior stroke, and history of hospitalization in the year prior to cardiac rehabilitation start, hospitalization rates at 12 months were compared among HBCR and CBCR groups. Among 754 women who participated during the study period, 382 participated in HBCR and 372 participated in CBCR. Baseline demographics are presented in Table 1. After propensity score matching, women who participated in HBCR had similar hospitalization rates at 12 months, 17.0% (95% CI: [13.2%, 20.8%]) compared to women who participated in CBCR, 16.4% (95% CI: [12.1%, 20.8%]) (Figure 1). In a propensity-matched, racially diverse population of women with cardiovascular disease, 12-month hospitalization rates were similar between women who participated in HBCR and CBCR.
Abstract 9377: A Role for Targeted Colchicine Uptitration in Recurrent Pericarditis: A Ten-Year Experience of Treatment Refractory Disease at a Specialist Referral Center
Authors: Claire J Peet, Bella R Mapalo, Michael R Wood, Charalampia Papadopoulou, Ovgu Kul Cinar, Francesca Capon, Helen Lachmann
Journal: Circulation (2022)

Introduction: Recurrent pericarditis (RP) carries significant morbidity, both direct and indirect through corticosteroid dependence. Uptake of highly effective anti-interleukin-1 agents, anakinra and rilonacept, is limited by expertise and cost, leading to widespread corticosteroid use in cases refractory to low dose colchicine. Thus, effective, accessible approaches that minimise iatrogenic harm are needed. Consensus guidance for other autoinflammatory diseases recommends colchicine uptitration prior to addition of biologics, providing a potential approach in treatment-refractory RP. Methods: Retrospective review of RP case records at a tertiary center 2012-2022. Treatment-refractory RP was defined as active disease despite colchicine 1mg/24h or disease requiring other prophylactic drugs, and corticosteroid dependence as daily corticosteroid use for 6 months. Results: Of 111 cases, 71 (64.0%) were treatment-refractory at 1 st review, of whom 32 (45.1%) were corticosteroid dependent. Median follow up was 15 months (IQR 4-35). Of treatment-refractory cases without corticosteroid dependence, 38/39 (97.4%) were treated with colchicine uptitration and 4/39 (10.3%) with anakinra; none became corticosteroid dependent. Of corticosteroid dependent cases, 27/32 (84.4%) were treated with colchicine uptitration and 11/32 (34.3%) with anakinra. Corticosteroids were discontinued in 18/32 (56.3%): 7/18 (38.9%) weaned with colchicine uptitration alone, 9/18 (50.0%) with anakinra and 2/18 (11.1%) with azathioprine. Median corticosteroid duration was 15.5 months (IQR 12-44.75) and corticosteroid toxicity occurred in 8/32 (25.0%). Among the 70/71 cases (98.6%) treated with colchicine (median maintenance dose 2 mg/24h (IQR 1.5-2)), permanent discontinuation was uncommon (3/70, 4.3%) and due to gastrointestinal symptoms; self-limiting liver transaminase elevation was common (28/70, 40.0%) but did not lead to discontinuation in any case. Conclusions: Colchicine uptitration enabled avoidance of new corticosteroid dependence, facilitated corticosteroid discontinuation and was well tolerated. This contrasts with the frequent toxicity seen with prolonged corticosteroid use and supports wider uptake of this approach in RP.
Abstract 9803: Randomized Comparison of a Radiofrequency Wire versus a Radiofrequency Needle System for Transseptal Puncture
Authors: Thomas A Dewland, Edward GERSTENFELD, Joshua Moss, Adam C Lee, Vasanth Vedantham, Randall J Lee, Zian Tseng, MD, Henry H Hsia, byron K lee, Grace Wall, Kathleen Chang, Michelle Yang, Gregory M Marcus
Journal: Circulation (2022)

Introduction: Transseptal puncture is a necessary component of many electrophysiology and structural heart procedures. A new technology utilizes a specialized introducer wire to cross the septum with radiofrequency (RF) energy, eliminating the need for a transseptal needle and wire/needle exchanges. The RF wire technique, however, has not been evaluated in a randomized trial. Methods: The Wire Instrumentation with Radiofrequency Energy to Impact Transseptal puncture (WIRE IT, NCT04645342) study was an investigator-initiated and designed trial that enrolled individuals ≥18 years of age undergoing double transseptal puncture for atrial fibrillation or left atrial flutter ablation. Participants were randomized to a transseptal approach with either a RF needle (NRG Transseptal Needle, Baylis Medical) or RF wire (Versacross RF Wire, Baylis Medical). The primary outcome was time to achieve first transseptal puncture. Timing was started at insertion of the guidewire into the short femoral vein sheath and was stopped once the transseptal sheath was positioned in the left atrium and the dilator and guidewire were removed. Secondary outcomes included second and combined transseptal puncture time, fluoroscopy time, number of equipment exchanges, and complications. Results: A total of 75 participants were enrolled between November 30, 2020 and February 2, 2022 (36 RF needle, 39 RF wire). No crossovers occurred. Randomization to the RF wire resulted in a statistically significant reduction in first transseptal time compared to the RF needle (Figure). Second and combined transseptal times and number of equipment exchanges were also reduced with the RF wire. One participant in the RF needle group experienced transient AV block due to mechanical trauma. There were no complications in the RF wire group. Conclusions: The RF wire technique resulted in faster time to transseptal puncture and fewer equipment exchanges compared to an RF needle with no difference in complications.